Addiction can contribute to infant removal if ‘safety threat’ present

December 29, 2018

It’s supposed to be a joyous time for families, but the arrival of a new baby may also bring stress and heartache for some.

For instance, if there is parental substance abuse, the state may determine there is a safety threat to the newborn, and the child could be removed from the home even before it leaves the hospital.

Matt Wallen, director of the Children & Family Services division of the Nebraska Department of Health and Human Services, said that while there are no regulations calling for automatic removal due to drugs, a referral may be made to the county attorney for court oversight of a case involving a family with a potential substance use disorder.

“Substance use, regardless of the type, may be a contributing factor to the reason a child cannot continue to reside safely in the parental home, but it is not the lone factor. The parent’s substance use must be linked to a safety threat,” Wallen said.

If a determination is made that a caregiver cannot or will not meet the child’s immediate needs for supervision, food, clothing and/or medical or mental health care, DHHS will contact law enforcement or the county attorney to request out-of-home care as the safety intervention.

In the case of a baby yet to be born — or a newborn — DHHS would likely find out about parental substance abuse via the doctors caring for the mother and the child.

Dr. Renee Albin, an OB-GYN at Women’s Health of Northeast Nebraska, said there are several signs that may point to maternal drug use.

“They may not seek prenatal care because they feel they can’t stop (using drugs), and they don’t want to even address the possibility that if somebody finds out, their baby is going to be taken away. There are certain questions (doctors) can ask that would direct us to do some further assessment,” Albin said.

Oftentimes, Albin said she first meets the mothers who abuse illegal drugs after they have been admitted to the hospital and don’t have their own physician. At Faith Regional Health Services in Norfolk, obstetricians rotate in the emergency room and in labor and delivery in terms of seeing patients who have not had prenatal care.

The number of mothers battling substance abuse has increased over the past few years, Albin said, and the drug most often at fault is methamphetamine.

Referring to digital medical encyclopedia UpToDate, Albin said methamphetamine crosses the placenta in a pregnant woman.

“That means it gets to the baby. There is the chance of maternal and neonatal (infant) morbidity (diseased or symptomatic of disease) and mortality (death). Methamphetamine can increase the growth restriction and cause gestational hypertension (high blood pressure), pre-term birth and other issues,” Albin said.

Because of these possible complications, Albin said doctors do contact DHHS if they find out a mother-to-be is using drugs.

“(DHHS) are the ones that are proficient and up-to-date on the requirements of what to do in those situations. What we as doctors think seem logical and appropriate may not be the correct legal thing,” Albin said.

“It seems things have to be pretty significant for the baby to not go home with the mother. ... Sometimes we’re surprised which babies stay and which babies don’t.”

IF THE DECISION is made to remove an infant from the mother’s care, Wallen said the DHHS CPS (Child Protective Services) worker will determine if there is a non-custodial parent who can care for the child.

If not, adult siblings are considered as are homes in which siblings may be residing. Other relatives and any kin are also searched for, but if no familial options exist, the child is placed into a foster home.

“If a removal becomes necessary, reunification is the state’s primary permanency goal, and we take an active role in assisting families who wish to achieve this type of permanency after a removal,” Wallen said.

Sometimes, a baby whose mother abused illegal drugs is born with neonatal abstinence syndrome (NAS), which is when the infant experiences withdrawal from being exposed to a substance before birth.

This may require the infant to receive medical intervention

Symptoms of withdrawal can typically be seen within the first few days of life to one or two weeks after birth, depending on the type of drug used and the time and amount the mother used, Wallen said.

Symptoms are rated on a scoring system, and if the baby scores a certain level, it is treated with medication to decrease their symptoms.

Non-pharmacological care includes swaddling, dim lights, low noise, pacifier, holding and rocking.

Wallen said that a pregnant woman who wants to stop using drugs would be referred to the appropriate services or community resources for help. Albin said there are medications that can be used to help a mother stop using drugs during pregnancy.

She referred to a study which shows that many pregnant mothers are highly motivated to stop using drugs, with 57 percent doing so. However, those women have a higher rate of resuming drug use after the baby is born.

“But during pregnancy, they’re motivated to stop. I highly recommend getting prenatal care, putting the baby first. These women need to take good care of themselves and their baby during that prenatal time period and know that there are resources, there are places that want to help them to stop.”

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